Pros and Cons of Low Carb Diets – Part 1

The topic of the risks and benefits of low-carb diets will probably turn into a series of posts. It’s a big topic requiring some degree of analysis and contemplation. To kick off the series, I’ll begin with a single post on the pros of low-carb eating. I think the cons will need to be broken out into at least two. Hey, might as well start out by saying a few nice things about one of my favorite ways of eating before digging into it’s risks when over-zealously embraced and promoted.

Before we begin, it’s important to define some parameters as to degree and demarcation of what constitutes low-carb. It’s easy to assume that low-carb eating means being in a state of constant ketosis via a ketogenic diet. It’s the condition of “Perpetual Atkins Induction,” which is defined as 20g of carbs or less per day. If that number isn’t already permanently etched into your brain, then be sure to remember it. We’ll be coming back to it shortly.

From what I can tell, nutritionists (the mainstream variety) consider anything under 200g of carbs per day to be low-carb. Some may set the cutoff a tad lower and call it at 150g per day. Folks in the low-carb and associated communities tend to consider 150g per day as a full-on carbo binge and a recipe for developing t2 diabetes. For the sake of this discussion, let’s classify low-carb eating to be in the range from zero carbs to 200g of carbs per day. There are some categories within low-carb with the ketogenic diet being at the lowest end of the range:

Ketogenic Diet or Very Low Carb Diet (VLC): 0-50g

Low Carb Diet: 50-130g

Reduced Carb Diet: 130-200g

Balanced Diet: 200-300g

High Carb Diet (high-activity): >300g

When I first embarked on low-carb eating almost twenty years ago, I bought into all the purported benefits and advantages of reducing carbohydrate intake to an ever vanishing amount. My favorite principle was the metabolic shift that occurred when going into a state of ketosis and transforming myself from a “sugar-burner” to metabolically advantaged “fat burner.” This concept was first put forth by Dr. Robert Atkins in his New Diet Revolution book and then wrapped in terms readily embraced by the body building community by Dr. Mauro G. Di Pasquale in his own work entitled The Anabolic Diet. As I would discover years later, this concept was highly flawed and actually downright incorrect.

The nutritional alchemy behind low-carb diets made no difference to me at the time. and in fact, this naive believe aligned perfectly with a semi-youthful quest to pack on lean muscle mass. My faith in this belief was reinforced that such a way of eating had made me noticeably leaner. It took several more years to realize that though I was noticeably leaner, the perceived muscularity was an illusion brought about by… well, simply being leaner and more vascular. I was also discovering that no amount of effort in the gym could compensate for the lower energy levels and the corresponding decrease in strength I was experiencing.

Perhaps one advantage I have when it comes to discussing and evaluating low-carb eating is that I’ve been doing it for so long.

The aforementioned twenty year span covers the periods of my life from my late 30s while I still had some of the raging testosterone from the previous decade that drove my devotion to exercising with weights, through my 40s when those hormonal levels began taking a noticeable dive, until today where I’m on the threshold of entering the sixth decade of my life where everything seems to be an enormous effort – both physically and mentally. Through it all, I’ve paid close attention to carbohydrates. During the early days and for many years thereafter, I counted every last carb and wore my “20 net carbs per day or lower” goal as a badge of honor, though I was realistic enough to know that I could never take things to zero. In theory, our metabolisms may not need carbohydrates, but in practice, it’s a completely different story.

OK, let me list off a few the advantages/benefits of a low-carb diet. Most of these are observational and anecdotal in nature, having come from my own experience with this way of eating and also from observing the reported experiences of others from various places such as online forums, Facebook groups, blogs, and from firsthand accounts of friends and acquaintances.

An important side note: I won’t be listing any of the claimed benefits for LC with respect to those – primarily epileptic children – suffering from neurodegenerative diseases. These benefits are associated with a very low-carb, ketogenic diet and though important, have little to do with the motivations of the vast majority of people seeking out low-carb diets.

It’s Easier to Count Carbs than Calories

If nothing else, Dr. Atkins’ brand of the low-carb diet got people to focus on the number “20” – the total amount of carbohydrates in grams required to be consumed per day during the Induction phase of the diet. What could be easier than keeping a running total of a single macronutrient? OK, a magic weight loss pill comes to mind, but short of that, it’s vastly easier to count carbs than tally up the total calories for everything you eat, which for even the simplest meal, might consist of several food items. With carbs you can ignore things that don’t contain appreciable carbs such as meat, fish, etc. and once you get into the groove, you can simply perform a mental estimate that is often pretty close to actual totals.

The problem with obsessing on a single macronutrient and setting a maximum threshold that going over is cause for a great deal of shame is that it becomes the reverse of too much of a good thing. In the case of carbs, people often figure that if I’m losing weight at 20g of carbs per day, then let me take it down to 15, 10, and eventually 0. It eventually becomes the equivalent of a China Syndrome meltdown if allowed to run uncontrolled.

Reduces Cravings and Appetite

The focus on carbs is a result of the delusion that calories don’t matter – only the quality of those calories truly matter. What low-carb dieters – at least most of the diehards – don’t understand is that by removing a great deal of the sugar in their diet in the form of sweets, bread, pasta, and to some extent potatoes and rice, they are suppressing their cravings for sugar which in turn suppresses their overall appetite thus resulting in lowering their daily caloric intake. In the end, they drop real (fat) pounds after the dramatic initial glycogen and water weight drop. Unfortunately, many proponents of this diet cheerlead from the sidelines and cajole practitioners to gobble up ever increasing quantities of butter, bulletproof coffee, steak, and bacon. The sad reality is the thermodynamic piper will have to be paid at some point in the form of stalled weight loss or in many cases – reversal of all and any weight loss.

It Tricks You into Eating More Veggies

We may have pitched a fit at the dinner table when mom laid down the law and said we had to finish our Brussels sprouts or there would be no dessert, but once on a low-carb diet we find creative ways to get in every last ounce of vegetables from roasted Brussels sprouts to faux pizza made from pureed cauliflower “dough.” Nothing wrong with this, it’s just unfortunate that the other plant group in the way of fruit becomes villainized with the same brush to tar ice cream, cheesecake, and Reese’s Cups. Granted, some people are extremely glucose sensitive that too much fructose from fruit can cause a wild ride for their blood sugar levels. This is why a period of carb reduction to break sugar cravings and allow for the gradual reintroduction of healthy carbs in all their forms including fruit, grains, and starch up to the individual’s threshold for carbohydrate tolerance.

It may help with certain health issues

This is a controversial topic and I can only present my experience with an autoimmune condition of my own as well as relate a few anecdotal success stories. I suffered with plaque psoriasis for a good portion of my adult life. It wasn’t a serious case – certainly nothing approaching full body coverage – it was mainly just on my elbows and back of my forearms. Mostly just on my right side. Creams of various strengths moving up to strong corticosteroid creams and even injections of these compounds failed to provide long term improvement. In fact, the injections made things worse by causing the skin on my elbows to thin to the point where simply bumping an elbow would cause profuse bleeding.

I did manage to get noticeable improvement about 15 years ago with a new steroid cream, but it never quite cleared up the plaques and ceasing use would cause the plaques to rethicken. Around the same time I had been experimenting with low-carb dieting off and on for a few years. I had begun to notice that each time I went on the diet that my plaque psoriasis would greatly improve regardless if I used the corticosteroid creams or not. I’ve been off all dermatological medications for over five years and no longer have a trace of psoriatic plaques.

I can’t conclusively chalk it up to eating low-carb and it’s quite possible that I simply outgrew the disease. It does happen and psoriasis has been associated with emotional stress. Several variables to consider in this case and I certainly didn’t conduct a proper medical study – even on myself – draw any valid conclusions, regardless, I think it warrants a proper study or two. Conversely, during the course of writing this post I came across a blog comment where a woman claimed that low-carb eating triggered an outbreak of psoriasis, so perhaps, LC creates a form of stress that can trigger the condition.

I have also read and heard from others on low-carb diets that they’ve seen noticeable improvements in rheumatoid arthritis and gastrointestinal conditions with an autoimmune basis such as IBS and Crohn’s Disease.

Dietary cholesterol, saturated fat, and sugar and their impact on blood lipid levels and in turn what the ensuing numbers mean with regard to cardiovascular disease and atherosclerotic plaques is another volatile topic and one which deserves a separate discussion. There is ample evidence that LC can affect blood lipids both positively and adversely.

The link between diabetes and heart disease is well-known and under the proper circumstances, a low-carb diet can improve diabetes, which should in turn improve the subject’s outlook with respect to CVD. In my own case, my blood lipids – total cholesterol, HDL, triglycerides, and LDL – have all improved while eating low-carb, however, I had also been self-administering Niacin (B3) and red yeast rice during the periods when blood tests were performed. I’m unwilling to forgo either regimen for the sake of scientific testing and for the record, I’ve never been a big consumer of saturated fat, though I do eat it without guilt or concern when a meal would be better enjoyed with it.

Update (5/14/2015):

In my haste to enumerate all the terrific benefits of a low-carb diet, I overlooked two additional bennies:

Reduction of dental caries and improved oral health – diets containing high amounts of sugar promote tooth decay. I have a mouth full of ugly gray amalgam filled molars as proof. I’m not sure when the Philly region where I grew up began fluoridating its water supply – most of America had instituted it by 1961 when I was 4 – but with or without it, my diet and oral hygiene habits didn’t help matters. My childhood diet of white bread, pasta, pizza, and sweets left a sticky plaque that coated my teeth and it provided a steady source of business for my dentist. To this day, I can visibly notice the difference in the degree of plaque that accumulates on my teeth depending on my consumption of wheat and sugar-containing foods [1].

Of course, adequate and proper dental hygiene is most likely the most important factor in preventing dental problems, and without getting into the controversial issue of feeding a low-carb diet to children, it probably wouldn’t be considered abusive or negligent to restrict the amount of added sugar in the form of soft drinks and candy in a child’s diet. It then comes down to a question of which is harder: restricting sweets or getting a kid to brush his teeth on a daily basis?

Reduction in acid reflux episodes – I used to experience heartburn on an almost daily basis. Heartburn so extreme that I used to gobble Tums antacids two at a time. It would often disrupt my sleep. Pizza was a major offender. I used to think it was the garlic or even the tomato sauce that caused these flareups. My bouts of heartburn all but vanished the first time I began a low-carb diet. It took me a while to notice a connection and of course, pizza had been relegated to the sideline while eating low-carb.

As close as I can tell, the root cause was the presence of wheat products (unrefined wheat flour in pizza dough) along with gastrically irritating foods such as garlic, onions, hot peppers, and certain spices. Perhaps gluten – that perennially bad guy – is the actual culprit. Fortunately, I’ve been able to have my pizza (and bread) and eat it too. Simply by greatly reducing the total quantity of gluten contained in a food, I can enjoy these beloved food items once again without digestive stress.

Babies and Ketotic Bathwater

A pervasive cry from the low-carb community – at least among those who acknowledge that dogma exists – is let’s not get all crazy and stuff and toss out the baby (LC benefits) with the bathwater (dogma, carbophobia, and blind adherence to ketosis). I count myself among this group. This sentiment will be revisited after we have a look at the risks of low-carb dieting. Most of the risks are concentrated around the VLC and ketogenic approaches to the diet, but also extend into daily carbohydrate ranges above these extremes. I have my work cut out for me in performing the background research and data gathering for these upcoming posts, so I better carb up and get my butt in gear!